When all else fails, advocate

What do you do when you see a patient and you believe the treatment that they are getting is incorrect or that they are completely being neglected and not getting any care at all?

In a developed country like Australia, it is easy, you can speak to a staff member, speak to a patient liaison officer, speak to a Doctor and raise the issue in the hopes that someone will take notice and at least give a rationale for treatment they have given or correct the wrong doing.  Something is generally done.  Not the case in a developing country such as Kenya.

A house fire, rescued by her mother 8 days ago.  Maria* had been brought here and taken to surgery for a fasciotomy of her limbs (where the skin on the limbs are sliced to prevent the swelling for constricting the blood supply).   One shot of morphine before her daily soak in the tub, a rub down with some dermazine cream and that was it.  No IV fluids, no dressings, no debridement of dead skin, no regular pain relief, no nutrition through a naso gastric tube, and even more staggering, no doctor review for 7 days.

I ask who the sister in charge is on the ward and the nurse says to me that she is.  She says with true conviction (and I believe that she honestly did not know better and this is the issue with different education systems) that the skin would eventually fall off and new skin would grow.

I stared at baby Maria and I turn to one of my colleagues and I say ' she is going to lose those 2 feet' I didn't realise i had said it too loud or that the mother spoke English but I noticed her face drop immediately and she turned to look at me.  My heart just landed in my stomach as I realise she has understood what I have said.  I reassure mum and turn to my colleague and give het a look of 'shit 8 can't believe she just heard what i said. I am mortified and I could just cry.

I ask when they will Take down Maria's dressings again so I can come and take a look at her wounds.

Tomorrow we will soak her again 

How naïve am I.  I thought that dressings were being applied.  We head back to where we are based and I speak with the head of the hospital. I tell him that I saw this little baby with burns and he says if i think it is that bad perhaps our doctor can come tomorrow.  I am relieved i feel like something is being done.  I contact the organisation and I ask if it is possible if i do a call out o Facebook to help baby Maria and fundraise to get her to a bigger hospital.  I am told it had to be discussed by The board in a meeting.

The next day I get the news that the board has said no it goes against out policy as an organisation.  I cry.  My heart is broken and I can't stop crying that day we go out to our clinic and on the drive I cannot help it, I speak to the director of the facility and I tell him that I can't fundraise for her so he rings the doctor for our facility and he asks her to join us in the afternoon at that big hospital where baby Maria is so she can assess her. The news is not good. In the meantime I contact my friend who is a Doctor and see if there is a way we can get her flown out? unfortunately her injuries are too severe. There are moments when you are humanitarian nurse where you want to do the best that you can but unfortunately you keep hitting brick walls but i try tirelessly. whilst there are many parts to this story i will end this here. Would believe this has been sitting in my folder idle since 2020 since i got busy with the pandemic and this story never got finished. I will tell the full story one day but the for those of you that ask, baby Maria did die of her burns injuries, her mother did not leave her side. 

What can you do as a Nurse when you see wrong treatments that are not best practice? you educate.

I went around for days teaching you Doctors and Nurses Emergency Burns treatment for paediatrics based on the protocols from the paediatric emergency department where i worked. I left the protocols behind so the hospital had a guide to follow. Knowledge empowers others and this is how change is created.